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Cutting for Stone, by Abraham Verghese

Cutting for Stone (2009) isn’t directly autobiographical, but it has a bit of a documentary feel to it. This is because Verghese did have some of the Ethiopian and American experiences he writes about, and also because his career, other than being a writer, is as a doctor. The extensive medical detail in the book reflects his lived experience. It took a while for me to get into this book, but then I found it hard to put down.

The story begins with Marion Stone at the age of fifty looking back at his life in order to understand his relationship with his brother, and his father. Marion– named after the famous gynaecologist Marion Sims – and his conjoined twin Shiva were born in the ‘Missing’ hospital – a corruption of ‘Mission’- in Addis Ababa in 1954. Their mother, Sister Mary Joseph Praise, an Indian nun, died at their birth, and their father, Thomas Stone, a surgeon at the hospital, fled the country for reasons that seem heartless, but become clearer as the story unfolds. The boys are brought up at the hospital by Hemlatha (Hema) and Ghosh, the doctors who separated them at birth. They grow up with an expatriate perspective on the richness and colour, but also the poverty and political instability of Ethiopia. Each goes on to pursue a career in medicine, but of completely different kinds. And then there is Genet, the Eritrean girl they have grown up with. Where does it all go wrong?

The book is divided into four parts, though parts one and two only make up a third of the book. We know from the prelude that Marion is trying to reconstruct his past, and most of the book is narrated by him in the first person. However there is only so much that he can recount from personal knowledge, so the story in the shorter parts one and two is carried by others, such as Hema and Ghosh. These sections of the story, including that relating to his mother, are told in the third person. Later is the book, Verghese relies on having another important character tell his story to Marion. I find this mixing of first and third party accounts to be an annoying device, and it probably accounts for my initial difficulty in getting into the story. Once Marion takes over in part three, I felt much more comfortable with it. (Part three is his growing up in Addis Ababa, part four his time in America.) However there are some events which are crucial to the story – two in particular – which happen, as it were, off-stage. Marion doesn’t take part in them, so can’t possibly describe them but Verghese hasn’t chosen to give the relevant characters – Shiva and Genet – voices of their own. So we are left with only Marion’s perceptions, and the effects of others’ actions on him, rather than an understanding of why they acted as they did. I’m probably being a bit harsh here; both Shiva and Genet are fully developed characters whose behaviour is consistent with the picture Verghese has drawn of them. But their actions are ultimately a function of plot more than character; they do what they must do for the working out of the mechanics of the story. And these mechanics are to my mind just a bit artificial. I was completely convinced by Marion, Hema and Ghosh, but not quite fully convinced by Sava and Genet.

The book is very long, largely because Verghese loves detail. And much of it is fascinating. You may or may not like the attention given to surgical procedures – it got a bit much for me sometimes – but it certainly gives a strong sense of reality to the book. Attitudes to medicine and its practice are central to the story, summed up when Marion thinks ‘Surely you couldn’t be a good doctor and a terrible human being’. Verghese’s own surgical practice has been very patient orientated – in the sense that you can learn more about patients’ needs by talking to them then you can by looking at data about their condition. The question ‘what treatment in an emergency room is administered by ear’ and its answer ‘words of comfort’ is important in the story. Verghese turns naturally to medical metaphors; speaking of a rift with his twin, Marion says: ‘If there were filaments and cords of yoke or flesh that kept our divided egg sticking together, I was taking a scalpel to them.’

The title, Cutting for Stone, is taken from a version of the Hippocratic oath which enjoins doctors not to operate to remove bladder (presumably?) stones, but to leave it to ‘surgeons’. This slightly enigmatic – and no longer used – formulation sounds more like an ancient demarcation dispute than a useful piece of advice, and I’m not sure of its application to the story. Certainly there are many references, or allusions, to cutting in relation to people called Stone; Thomas Stone fails to perform a caesarean section on the twins’ mother, the conjoined twins are cut apart, Marion could be said to be cutting for Stone in looking for his father, and there is other cutting which I won’t mention because it gives away the story. There is also division and conflict in Ethiopia. Perhaps the point is that cutting is one side of the coin and healing is the other – just as Marion is the mirror image of Shiva. Both of the twins, Hema, Ghosh and Thomas Stone all seek to heal, which is what I guess this book is ultimately about. Marion cannot heal the rifts in Ethiopian society, but he does what he can to heal its inhabitants.

You can read more about Abraham Verghese here, and note the places where his experiences, and those he gives to Marion, coincide. And here is an interesting TED video in which he talks about the need for the human touch in medicine.